Utilising a ‘Community of Practice to support pharmacists to work in residential aged care: protocol for a longitudinal evaluation

Background and rationale

Communities of Practice (CoPs) are defined as: ‘groups of people who share a concern, a set of problems or a passion about a topic and who deepen their knowledge and expertise in this area by interacting on an ongoing basis… These people don’t necessarily work together on a day-to-day basis, but they get together because they find value in their interactions, as they spend time together, they typically share information, insight, and advice. They solve problems. They think about common issues. They explore ideas and act as sounding boards to each other. They may create tools, standards, generic designs, manuals, and other documents; they may just keep what they know as a tacit understanding they share… Over time, they develop a unique perspective on their topic as well as a body of common knowledge, practices and approaches. They also develop personal relationships and established ways of interacting. They may even develop a common sense of identity’.1 Essential elements of CoPs include the following:

1. ‘Social interaction of members with each other through formal, informal or technological settings.

2. Sharing of relevant knowledge between each member.

3. Collaboration between members to problem solve or create new knowledge.

4. Fostering the development of a shared-identity among its members’.”2

CoPs have been widely used in different sectors, including healthcare, business and education.3 Within the healthcare sector, CoPs have been used to facilitate knowledge/information exchange, improve practice and facilitate the implementation of evidence-based practice.4 Extant evidence within the healthcare sector suggests CoPs improve outcomes in developing local guidelines/policies, use of screening tools, greater involvement of patients in decision-making and improved adherence to evidence-based practice indicators;4 such benefits could serve to address current issues within the residential aged care sector.

Internationally, the implementation of evidence-based guidelines and overall knowledge translation within the residential aged care sector is plagued by barriers such as inadequate staffing levels, lack of staff knowledge/training and lack of resources.5 Within Australia, initial evidence suggestive of substandard care of residents prompted a federal inquiry through the Royal Commission into Aged Care Quality and Safety.6 With the final report by the Royal Commission, a recommendation was made to increase staffing numbers to include the employment of at least one pharmacist per residential aged care facility.6 As this is only a recommendation, residential aged care facilities are not mandated to employ pharmacists; however, the Australian Government has committed to investing AU$350 million for community pharmacies to employ pharmacists to work onsite in residential aged care facilities.7

Onsite residential aged care pharmacist roles are in their infancy in Australia, with only one published pilot programme to date.8 As such, pharmacists who will transition into this new role will require support in competently fulfilling their new roles. Furthermore, current reports indicate that only one full-time equivalent pharmacist will be employed per 250-bed facility; this will mean that many pharmacists working in this new role will be working in professional isolation from other pharmacy colleagues.9 A CoP can thus provide an avenue for social interaction, shared learning and knowledge translation. Certainly, extant evidence suggest that a virtual CoP is desired by pharmacists working in family medicine groups (General Practices), an emerging role in pharmacy practice.10 However, it is unknown whether CoPs can support pharmacists to work within a new role that has not yet been formally established; its utility in facilitating knowledge/information exchange, improving practice and implementing evidence-based practice in this context is also unknown.

Objectives

This proposed project incorporates the development and longitudinal evaluation of a CoP intervention to support pharmacists transitioning into the residential aged care sector. Specifically, we primarily seek to evaluate the processes and outcomes of a CoP that is designed to support pharmacists to work within the residential aged care sector, over time.

We are also interested in exploring pharmacists’ perceptions and experiences with the CoP intervention in supporting knowledge/information exchange, improving practice and implementing evidence-based practice.